The minimum structure
Operating receives payer deposits and pays expenses. This is the account in every EFT enrollment. Tax reserve gets a fixed percentage of collections on a schedule (your CPA sets the rate). It prevents the most common first-year injury: spending the IRS’s money. Savings holds everything above the operating threshold, somewhere that pays yield.Decisions with a long tail
Which account receives payer deposits. Semi-permanent. Judge a bank on whether you’d run payer money through it for a decade, because re-enrollment is the exit toll. Who has access. Role-based access from day one: the office manager views and initiates below a limit, you approve above it. Practice embezzlement is an insider event, and dual control is the cheapest insurance there is. Where paper arrives. Some payers and patients will always mail checks. Pick one intake point (front desk, PO box, or lockbox) with one accountable owner. Deposit insurance. FDIC covers $250k per depositor, per bank (FDIC). A healthy practice exceeds that fast. Options: multiple banks, sweep networks that spread balances across many insured banks, or conscious concentration risk.Multiple entities
One entity, its own accounts, no exceptions. Money crosses entity lines only as documented transfers consistent with your management agreements. This is an MSO-PC compliance requirement, not a bookkeeping preference. See practice banking structure and the MSO-PC Wiki.Lemma aside: Lemma is built for this pattern: per-entity accounts in one dashboard, automated sweep rules, role-based access with approval limits, yield with expanded FDIC coverage, and a lockbox per entity.
Where next
Forming?
Choose your entity.
Operating?
Enroll in EFT/ERA.
Growing?
Buy a practice.